Provider Demographics
NPI:1922789056
Name:MENARD, KOURTNEY LYNN (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KOURTNEY
Middle Name:LYNN
Last Name:MENARD
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 CHARLIE ARCENEAUX RD
Mailing Address - Street 2:
Mailing Address - City:RAYNE
Mailing Address - State:LA
Mailing Address - Zip Code:70578-8421
Mailing Address - Country:US
Mailing Address - Phone:337-250-1221
Mailing Address - Fax:
Practice Address - Street 1:2021 CROWLEY RAYNE HWY
Practice Address - Street 2:
Practice Address - City:RAYNE
Practice Address - State:LA
Practice Address - Zip Code:70578-4027
Practice Address - Country:US
Practice Address - Phone:337-788-1328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA205518363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health